Eternal Hypochondria of the Expanding Mind

by Venkat on January 16, 2013

The story of neurasthenia or “invalidism” is a curious mid-nineteenth-century chapter in the story of the emancipation of women. As Barbara Ehrenreich argues in Bright-Sided, it was almost entirely a social phenomenon:

The largest demographic to suffer from neurasthenia or invalidism was middle-class women. Male prejudice barred them from higher education and the professions; industrialization was stripping away the productive tasks that had occupied women in the home, from sewing to soap-making. For many women, invalidism became a kind of alternative career. Days spent reclining in chaise longues, attended by doctors and family members and devoted to trying new medicines and medical regimens, substituted for masculine “striving” in the world.

What makes this curious, and rather ironic, is that invalidism was becoming widespread just as new possibilities were being opened up to women, through the slow substitution of fossil fuels for muscle power.

This was not a coincidence of course.

Opiates for the Masses

Invalidism was a peculiarly American condition that later spread worldwide. In fact, it was called “Americanitis” for a while. Besides middle-class women, men in certain middle-class professions, such as clergymen, whose social and economic roles were being disrupted, were also common sufferers of the condition.

The condition itself was a chronic cousin of the acute condition that used to be called a “nervous breakdown.” In both cases, doctors once believed that some sort of actual mechanical breakdown of nerves was involved. The symptoms were predictably vague: fatigue, anxiety, headache, neuralgia and depression. The treatments ranged from laudanum (a tincture of opium) to various patent medicines and electric shock therapy. These were prescribed treatments supplied by the medical establishment of the day, not surreptitious use of whatever drugs were deemed illegal by a prevailing social order.

The APA no longer recognizes neurasthenia, and it is tempting to dismiss it as a sort of socially induced and legitimized hypochondria to fill a vacuum of purpose. After all, medicine is much smarter and more scientific today. Instead of such pseudo-science around social maladies, we can now apply real medical science to real disorders like Generalized Anxiety Disorder. Instead of the dangerous or useless patent medicines of the nineteenth century, we can rely on billion-dollar pharmaceutical miracles. Instead of playing fast and loose with addictive opiates, we restrict ourselves to coffee and alcohol for the most part, carefully dispense prescription drugs, and ponder the case of marijuana with level-headed scientific caution.

Yes, I’ve decided I need to practice my irony in 2013.

But more seriously, the widespread use of prescription drugs (or more generally, socially acceptable psychoactive substances) to get large populations through tough transitions is a constant in history. Marx did not get it quite right. Religion is not the opiate of the masses; it only mops up what actual opiates cannot fix.

Drugs and grand narratives are inextricably linked in history. We can plausibly conjecture a precise relationship: the more incoherent the prevailing story, the stronger, and more varied, the drugs required to navigate it while the retconning is in progress. I’ve always found it odd that in the Dune science fiction series, the hyperspace navigators were the ones who lived suspended in a psychotropic “spice” melange: it is not those who can successfully navigate strange new realities who need drugs, it is everybody else.

Drugs might also cause transitions, not merely accompany them. During a recent discussion, a gonzo futurist friend (the term is due to Justin Pickard) mentioned a speculative theory about one cause of the European renaissance: the gradual shift from beer and wine to coffee and tea as the main psychoactive substances in daily life. There is something very appealing about the idea of an “enlightenment” being caused by a shift from depressants to stimulants.

In other words, to understand any chapter in the story of humanity, it is not enough to ask, what is the plot? and what were the archetypes of the day? We must also ask, what were they smoking?

There are days when I think that culture is primarily a function of what we smoke. I’ve gotten increasingly convinced, since I wrote the post on future nausea last year, that historigraphy is best understood as a branch of pharmacology.

Digging and Filling Holes in the Psyche

The individual psychology of what happens to at-risk populations during a major economic transition seems quite clear. An Oliver Wendell Holmes quote supplies the diagnosis: “The mind, once expanded to the dimensions of larger ideas, never returns to its original size.”

Parkinson’s Law supplies the prognosis: “work expands to occupy the resources available.”

Parkinson’s Law is usually applied to explain the creation of make-work in bureaucratic organizations, and is normally regarded as a pathology. But it is only a pathology when social constraints restrict the expression of a healthy underlying drive: to do meaningful things with available potential. When meaningful things cannot be found, meaningless and arbitrary things become acceptable.

For American women in the nineteenth century, it was a case of double-jeopardy: not only was their existing purpose taken away, they were prevented from pursuing opportunities that were opening up. Hypochondria expanded to fill expanding minds denied more interesting occupations. Medicine and narrative were skillfully woven together to prevent women from even recognizing their condition for the most part, supplying them instead with a futile activity with which to occupy their lives. Prevailing sensibilities were expanded to accommodate that activity via fashion. Ehrenreich quotes a biographer of Christian Science founder Mary Baker Eddy: “Delicate ill-health, a frailty unsuited to labor, was coming to be considered attractive in a young lady of the 1830s and 1840s.”

If medicine enabled a futile life script, fashion helped craft a narrative around it capable of surviving at least the scrutiny of a drug-addled mind.

It is tempting to apply the Myth of Sisyphus metaphor of rolling a rock up a hill here, but women were denied even an elevating and energizing absurdity of a life (Sisyphean activities are more common on frontiers, and generate their own intoxicants: kool-aid). Instead, they were offered a lifetime of digging and filling holes in their psyches.

It was not the first or last time in history the noble medical profession devoted a great deal of resources to its shadow purpose in civilization: helping societies navigate rough grand narrative shifts by appropriately medicating potentially troublesome groups. Which is all groups caught between safely fossilized rentier enclaves that can ride out tumultuous change, and chaotic frontier populations that can surf it to power and new wealth.

The story of civilization is the story of the one-eyed drunk on kool-aid leading the blind, who grope their way forward in a pharmaceutical haze, while secure gods gaze down from rentier heavens, sipping their champagne.

The Lost Generations of History

Why would a society, faced with vast opportunities opening up on an expanding frontier, not unleash the capabilities of an entire under-utilized half of the population to pursue them? Why drug it into uselessness?

The question crops up repeatedly in history, and the affected class is often some sort of prosperous middle class. Nineteenth century American women are just a particularly dramatic example. Sometimes, you can blame a malevolent external force, such as in the case of China during the opium wars, or alcoholism on Native American reservations in the United States.

But most often, societies that enjoy a good deal of control over their own fates do this to themselves. Between the eclipse and obsolescence of old institutions and the rise of new ones, there seems to be an unavoidable trough of lost potential, filled with anomie. In such troughs, you find the lost middle-class generations of history. Fragments on the cutting room floor of the human drama. Great art and great depressions (economic and psychological) seem to emerge from such troughs.

In America today, we have everything from Adderall to Zanax helping us find our way to a post-industrial economy, and everything from gun violence to social dysfunction being attributed to drugs.

If you really want to experience second-hand the eternal hypochondria of the expanding mind, try some of the recentwritings of Elizabeth Wurtzel, author of Prozac Nation, herald of the contemporary pharmacological age, and confessional narrative pioneer. I was unable to get through even a third of the first essay (the best part is the title: “Elizabeth Wurtzel Confronts Her One-Night Stand of a Life”), so I am not going to attempt the book. At first glance, Wurtzel’s life appears to be the farcical repetition of the tragic history of feminism, but viewed as a representative of a declining middle class, rather than women, her story still has elements of genuine tragedy.

There is nothing inherently problematic about using drugs to achieve a soft landing into a new economic order. A soft landing is a valuable thing. If major forces like steam in the nineteenth century, and the Internet in ours, are unleashed without restraint, institutions with the potential to endure, and the laboriously accumulated social capital within them, get swept away. Baby and bathwater alike are lost.

Minimizing Institutional Rubble

But just because soft landings into a new economy — which most people interpret as either preserving existing institutions or evolving them gradually — are desirable, does not mean they are possible.

The violence of a major economic transition, I’ve come to believe, is largely independent of human efforts at comprehension and control. It is simply the ungovernable outcome of a contest between the economic forces being unleashed and the capabilities of the institutions that must face them. Small forces are easily and non-disruptively absorbed. Large changes turn the prevailing order into a landscape of institutional rubble. The bigger the shock, the less control humans have over the speed and duration of the transition. Like 19th century Americans in the early decades of steam, we are living through a Magnitude 9 economic quake.

There is going to be a minimum amount of institutional rubble. The best we can do is ensure that there isn’t more rubble than absolutely necessary, and carefully choose which institutions to sacrifice, at every level of economic agency from individual to Congress.

This is a curiously counter-intuitive idea, because we are talking about dealing with an emerging plenty. Why can we not use the new resources to soften the impact? Enough pillows for all, and no pills, with nothing broken during the move?

This is like asking why we cannot use the energy of an earthquake to fuel the construction of sufficiently earthquake-resistant buildings. It’s the sort of deluded hope that drives inventors to seek perpetual motion machines and once drove alchemists to seek the philosopher’s stone.

Yet that is also the paradoxical sort of hope that generates the forces of creative destruction in the first place. I haven’t yet figured out the precise nature of the paradox, but I took a stab at identifying it a couple of weeks ago, via the parable of Schumpeter’s Demon.

When I get that story straight, I think I might understand the nature of wealth.

The hardness of the landing and the total amount of rubble are not up for debate. The question is: who gets the pillows with which to cushion the impact? The answer: the less doped-up you are during the transition, the more pillows you can grab.

In fact, we can substitute cushions and pills for guns and butter and repurpose the idea of production frontiers in Economics 101 textbooks to state a sort of hard-landings pareto principle: the mix of pills and pillows you can buy to navigate a transition to a new economic order is limited by the resources of the prevailing economic order.

Hard Takeoffs and Landings

When an institution fails to achieve a soft landing into a new economy, its occupants must fend for themselves. This is where drugs come in.

When we think of the pharmacology of grand narratives, our attention naturally turns towards the dramatic. If you watch Breaking Bad, you could be excused for thinking that small town Middle America is post-industrializing in a pale blue methamphetamine haze. All pills, no pillows. The perception would not be entirely unfair. Grand narratives are to some extent self-fulfilling prophecies, and meth-heads do seem to be having a disproportionate influence on that particular subplot of the story.

But it is the legitimate (or borderline) drugs of an era that tell the more important story. If the Prohibition in America marked the maturation of the Industrial Age, it is the abuse of coffee and alcohol that marks its decline. A line from Alain de Botton’s The Pleasures and Sorrows of Workhas stayed with me since I first read it:

Office civilization could not be possible without the hard takeoffs and landings effected by coffee and alcohol.

A civilization enjoying a period of relative calm, of the sort the Silents and Boomers enjoyed, can afford to to ritualize its drug use. I grew up drinking perhaps one small cup of coffee in the morning and one cup of tea in the afternoon. Now, like many Americans, I seem to down coffee by the unceremonious, burnt gallon. That’s what it takes to buy some pillows and avoid breaking bad.

We are about as far from the Japanese tea ceremonies and English afternoon tea as civilization can get. In fact, my de Botton routine has finally gotten to absurdity, now that I live in Seattle with its short days. I made up a little cartoon recently to illustrate this:

Let me hasten to reassure here: I exaggerate for comic effect. I am not yet a raging coffee-alcoholic (at least 2 people messaged me with concern when I posted the cartoon above on Facebook, and advised me to take more Vitamin D supplements; rest assured, I do take my Vitamin D quite religiously).

Jokes aside, the American Pacific Northwest does seem to be the epicenter of the ongoing economic quake. It is at once home to the prototypical enterprises of a globalized post-Internet world (Boeing, Microsoft, Amazon and the Port of Seattle, which handles a large chunk of American container traffic coming in from Asia) and the most determined efforts to deny that a transformation is happening at all, through an almost religious belief and engagement in small-and-local thinking. The region is chock-full of backyard humane eggeries, Arduino enthusiasm and coworking spaces.

The pharmacology of this regional transformation is a fascinating phenomenon. The state of Washington is the coffee capital of America, and recently legalized marijuana, but it endures some of the highest alcohol taxes in the nation. I don’t know what that adds up to (I am told the high hard alcohol taxes are primarily about supporting the local wine and beer industries).

Last weekend, during a getaway to Portland in neighboring Oregon, I stocked up on cheaper alcohol. I’ll save my take on Oregon and Portland hipsterdom for another rainy day.

Beyond Anomie

Rather strangely for me, I am feeling unusually optimistic these days.

Perhaps it is sheer surprise at having survived almost two years as a free agent without going destitute. Like Arthur Dent in the Hitchhiker’s Guide, I may have learned to fly by accidentally missing the ground while falling down. I have no clear ideas about how the emerging economy works, but apparently I have a place within it for the time being.

But I don’t think that’s really it. I see a cautious optimism catching on more broadly. It isn’t just me.

Perhaps it was the opportunity for a cathartic collective projection of anxieties that the Mayan apocalypse afforded us last year. Making jokes about a dramatic end-of-history scenario (my favorite was a repurposed Superstorm Sandy fake picture with Godzilla in it, re-captioned for the Mayan end-times) might have helped us dress right for a less dramatic end-of-chapter scenario. Or perhaps it was the fiscal cliff farce.

Whatever the cause, I am getting the sense that the worst of the psychological trauma of the transition may be behind us (the actual economic damage is probably yet to peak).

At the very least, we seem to be past the denial and anger stages of the Kubler-Ross process of mourning. We have accepted the impending demise of a way of life. The mainstream appears to be somewhere between negotiation and depression, and I think a few of us at least have moved on to acceptance.

It’s a start. I am going to try and sober up a bit and see if I keel over with future nausea or remain standing. If I do, I’ll try and figure out what to do with the rest of my life. Look for purpose and stuff.

Purpose and Stuff

I’ll leave you with one final idea today, about the relationship between purpose without institutions, under-utilized potential and prescription drugs.

Like many who have a background in the decision sciences, I have a strong belief in the power of regression focusing: the idea that working backwards from a goal is more tractable than working forwards from a prevailing situation. Many AI systems use regression focusing to simplify automated planning.

For humans, narratives grand and small, encoded within viable institutions and default scripts, are what supply purpose to human striving. Even when prevailing big-P purposes — such as space exploration in the last century — are hopelessly romantic, they serve to drive the story. Unattainable P-urposes seem to be the stones in our repeated attempts to brew stone soup (“Ah, but a man’s reach should exceed his grasp, or what’s a heaven for?” Robert Browning, who wrote that in 1855, lived through the industrial revolution, and was among those who managed to navigate it with optimism rather than despair; he was a trustafarian, but it would be unfair to hold that against him).

When prevailing narratives prove inadequate for filling the vacuum of purpose, anomie descends. And we head to the drugstore for something stronger.

In times of peace, we are born to purpose, into middle-class scripts. In times of chaotic change, finding purpose becomes the purpose. There is a neat little idea (due to Teilhard de Chardin I think; I can’t remember where I first encountered it or the exact quote) that “purpose is not given us in our lives, it is the work of a lifetime to find purpose.”

That is more true in some eras than in others. This is one such era. We are living through a period where our mainstream grand narrative is driven by an over-medicated, over-caffeinated and inebriated faith in the cargo cult of failing middle class scripts.

But to abandon the cargo cult and look for purpose is a risky undertaking. Anomie and uncomprehending what-hit-me destitution await those who try and fail.

Staying with the cargo cult is almost as risky, and getting riskier by the year. For many significant at-risk populations, the question is not whether to jump, but when. Too early or too late, and you get killed. Unsustainable arbitrariness is the fate of those who don’t abandon ship in time (more on cargo cults another day; they are becoming my latest obsession. My working hypothesis is that hipsterdom is one of many middle-class cargo cults emerging today).

I don’t know what the big P-purpose of the post-industrial age civilizational grand narrative is (it is definitely not space exploration), but there is a certain peace to be found in accepting a plurality of little-p purposes and smaller meanings while we figure it out. I find it encouraging that many are finding meaningful commitments in their individual lives, even as horizons shrink and triumphalist globalism wanes, just as it did during the Gatsby era in the early part of the twentieth century. This phenomenon can seem like fatalism (Bruce Sterling’s “Dark Euphoria”), but there is a chance it is merely an emerging healthy pragmatism.

When slowly falling expectation levels meet slowly increasing commitment levels, angst slowly starts getting squeezed out of your life. Life begins the day after you give up trying to figure it out. As one of my clients likes to say, it’s a beautiful thing.

Venkat, the epicenter of the transformation is not the Pacific Northwest. It is one center thereof, but San Francisco and Silicon Valley are epicenters of transformation also.

… I recall seeing my good friend’s dorm room at Stanford (I go there) and counting the alcohol bottles and losing count. Over a hundred liter bottles of hard liquor. I don’t know how it happens. Six coffee stores inside the campus itself, and I know of at least a dozen coffee places in Palo Alto. I wonder if a correlation could be made.

The Bay Area seems to be more of a bubble universe detached from the rest of the planet. Interesting things start there, but the real impact doesn’t become clear until things move out. PNR seems to be one of the first regions where the real impact becomes clear.

I got confused two parts of your post. I’m in middle of angst and the “figuring it out” so this post was quite interesting, it would be a great help if you could elaborate a bit.

1. You mention backward planning:
“I have a strong belief in the power of regression focusing: the idea that working backwards from a goal is more tractable than working forwards from a prevailing situation.”

in some previous posts you had argued about the virtue of the “path of least resistance” in a fast changing environment as it’s unpredictable. This seems to be somewhat different what you say here, so is your thinking had changed and if so how? (or it’s just that goals are useful for short term, or to many everyday predictable domains?)

2. In your last passages you talk about
“When slowly falling expectation levels meet slowly increasing commitment levels, angst slowly starts getting squeezed out of your life. Life begins the day after you give up trying to figure it out. As one of my clients likes to say, it’s a beautiful thing.”

My initial was that you meant “accept your state and move on, fulfill your destiny”. Second thought was about decision loops and that its an iterative, continuous refinement, but this passage sounds more like that there is a “life changing realization”.

I would be truly interested in your answers, thank you for the post, it was a great read.

The two are not in conflict. You can find the least-effort path to a goal. In fact that’s what most planning algorithms do (with different definitions of efforts/costs).

The presence/absence of a goal introduces a different type of simplification into thinking processes: if you know where you’re going, you can throw away things you will not need along the way. Like selling your winter coat if you’re moving to Hawaii.

Uncertainty does not mean no goals (deciding what to do when you have no goals always has a trivial solution: stay where you are). It merely means you may have to rethink your goals more frequently.

There are some rich investigation to be had in Ethnobotany, Anthropological/Historical Pharmacology and such like. And in particular the relationship between the predominant drug usage by thinkers and leaders in various historical cultures. Western imperialism and the spread of Christianity was largely driven by alcohol. The industrial revolution was financed by people fueled by huge quantities of alcohol and coffee. Meanwhile Indian Hinduism could be the dreams of an endless pantheon of gods embellished and imagined by generations of Gurus stoned on Cannabis. S American culture was efficiently organised and achieved with the help of Coca. Middle America and indigineous Americans have their cults of the Mescaline, Datura, Mushroom enhanced Shaman. As ever, these things have light and dark sides. The western wars were drunken fights. It’s a short step from cafe culture to “Greed is Good”. India has stoned choas as well as psychedelic art. Middle America had the Mayan death cults.

Fitting the Russians, Chinese, Mongols, Japanese, Africans, Muslims[1] into these theories is left as an exercise for the reader, as well the current transition from plant extracts to engineered drugs[2] hinted at in the article.

[1]Amanita, Opium, Khat, Hashishin, Belladonna, Salvia, etc
[2]Not just Medicinals like Xanax, Prozac, Valium but also LSD, MDMA and other recreational chemicals and their effect on concensus culture.

“… a speculative theory about one cause of the European renaissance: the gradual shift from beer and wine to coffee and tea as the main psychoactive substances in daily life. There is something very appealing about the idea of an “enlightenment” being caused by a shift from depressants to stimulants.”

Sounds a little like an extension of Terence McKenna’s theories that the shift from ‘primitive’ matriarchy to ‘civilised’ patriarchy was concomitant with the shift from psychoactives and entheogens to uppers and downers; from mind drugs to work drugs, in other words. McKenna was something of a maverick, but he’s a fun read; start with *Food Of The Gods*.

I don’t know if he mentions it in any of his published writings, but James Scott used to frequently talk about the way colonialism and neo-colonialism emphasized production of the “soft drugs” that fueled the modern factory economy: coffee, tobacco, and sugar. These substances helped enable workers to endure long hours, and thus production of these substances became a high priority. (That’s my slightly hazy memory of Jim’s point, at any rate.)

Fernand Braudel spends a good amount of time in Vol. 1 of Civilization and Capitalism discussing the discovery of distillation of hard liquor and the origins and movements of coffee, tea, sugar, and other stimulants through Europe, Asia and the Americas.

I was amazed at how recent they all were; for the most part, none of those existed in Europe prior to 1500.

Juan Cole, in Napolean’s Egypt, makes a wry comment at one point regarding how Yemeni coffee traded through Egypt may have fueled the French revolution (first cafe in Europe was in Paris, and cafes were loci for radicals). This was why the Ottoman empire tried repeatedly (and unsuccessfully) to suppress coffee and cafe culture.

Dale Pendell’s Pharmako/Poeia trilogy is a great source for random drug/culture connections (one of the volumes focuses on stimulants). Unlike some of the more academic works already cited, it seems to have a form appropriate to its content.

…We collected 1000 reports of 10 drugs from the drug information website Erowid.org and formed a term-document frequency matrix…Conclusion: Machine-learning techniques can reveal consistencies in descriptions of drug use experiences that vary by drug class. This may be useful for developing hypotheses about the pharmacology and toxicity of new and poorly characterized drugs.

I’m curious to see your future discussion of cargo cults, because as you’ve used the term it here seems to have traded some of its special meaning (e.g. association with colonialism in Papua New Guinea) for something a bit more banal.

Great to see some optimism and also a very accessible blog. (I’m hero-worshipping William James at the moment.)

The pharmacological focus of the blog manages to exclude all the other “opiates” such as TV, facebook, movies, porn, gaming, gambling.

One of my children occasional wakes up at night crying and half awake. He never remembers it in the morning. Apparently quite common. The thing that calms him is showing him a 10 minute kids TV show on my phone. It’s instantaneous…. scary…

There is a book called “Deep History and the Brain” that deals with colonialism from the perspective of demand driven by desire for stimulants, such as caffeine, sugar, chocolate, tea. By Daniel Lord Smail.

Instead of big and little P-purposes we have self-referential trends and fashions which are generated from a self-observation of culture. Hipsters don’t sell us kool aid as much as they try to anticipate the near future as the present of an already-arrived future, as the story of some enlightened people who already live ordinary lives in our own future. They eat the food everyone will eat, listen to the music everyone will listen, wear our future clothes, use our future gadgets and so on. The manufactured normalcy field ( MNF ) is not an autonomous entity but the product of the mediation of hipsters who see it shifting and create it by confirming its perceived shifts as those that have just happened. They turn excitement into tautologies: every cool kid/company uses X these days, so why don’t you? The implied transition is one between the getting “ahead part” of the human life cycle to the “getting along” one – the becoming of mainstream where you have to paddle in order to survive instead of riding the wave as you did before.

There is an opposite of Future Nausea, the sort of future that arrives in the form of resignation. All attempts to get ahead and away were tried out and failed and now you are left with Javascript for the rest of your working life. The creative-destructive cycle stops and inertia of the MNF kills the creative class. The former cool kids are burning in hell. They become moderate metaphysical social-democrats, they praise adulthood, begin to discover the “good parts” of everything, become realists and family fathers who have to pay mortgages and so life goes on and fades away.

Kay, you can add “Hipsters faking imaginative creativity by the endless recombination of the past” to that depressing meta-narrative. Way too much of this “already arrived future” is actually just the result of taking 2 or 3 things from the past, chewing and ruminating on them before then regurgitating the resulting mess as something “new”. And that’s before we get into the decadent and deliberate exploitation of patternwork in the cynical cocaine decision that is purely for the money. The Hollywood Franchise system, the TV talent show are just two examples of this Descent Into Patternwork.

That’s all depressingly negative. And that cynical negativity is also a key defining quality of the hipster Post-Process. But it doesn’t have to be like that, we can have retromania and neomania or we can have retrophilia and neophilia. Celebration of the past and joy of the new is also possible. It hasn’t all been tried and failed. This isn’t the end of history.

And by the way, grown up adults (and even wise old people) are part of the process as well, even after they’ve passed on the baton of progress to the next generation of youthful dreamers. They too have their place and have something useful to say.

I strongly recommend _The Frailty Myth_, which includes an account of the extent to which respectable Victorian women were expected to move as little as possible. It reached the point that they were less able to give birth safely, so special ladylike exercises were invented.

Nancy’s comment, above, reminds me of hysterical paralysis, an affliction of 19th century ladies that has since disappeared. It was both the ultimate manifestation of their expected passivity and (via Freud’s self-suppressed case studies) passive resistance to sexual abuse.

Our emotional pathologies match the expectations of our times. Today we have eating disorders and obsession.

I was interested to read about a true double blind study of antidepressants. Most so-called double blinds weren’t, because placebos don’t have side effects. The researchers used semi-placebos; not SSRIs, but having similar side effects. The difference in effectiveness between the SSRIs and the active placebos was zero. It makes the whole psych drug practice into an elaborate piece of theater.

Humans want emotional coherence more than anything, and we’ll stick whatever is necessary into the jagged hole to keep things together. Endless weekend self-help workshops, pharma, obsessions, chronic vague illness, whatever. I remember someone talking about people “getting good at their neuroses.” Right now we lack cultural coherence and a set societal path to finding purpose, so people will follow whatever pops up in their faces, like a baby duck imprinting on a human keeper or the family dog.

I remember hearing about an exchange between a European doctor and and African doctor. The European asked, “Why do you people spiritualize somatic disorders?” The African doctor countered, “Why do you people somatize spiritual disorders?”

Minor Heretic. Also beware the Nocebo effect. The non-existent side effects of a placebo can be real for a patient who expects to have them. This seems to work both ways. Placebos generate the side effects expected by the real drug you think you’re taking. And you can find the expected side effects when taking the real drug if you start looking for them. And you get the range of side effects depending on how anxious you are about the outcomes. So most people start feeling mild effects of those expected in 1-10 to 1-10,000 users. Only a few people are sufficiently anxious to invent those expected in less than 1-10,000.

And of course from a personal perspective all tests are on a sample size of one.

Oh, sure, the nocebo effect is huge. There are people who think they are sensitive to EMF and have all sorts of symptoms. Of course, when put to the double blind test the effect subsides into “no better than chance.”

The point is that when people know they are part of a study they will wait and see on the side effects.

My main point is that we will strive for a coherent emotional life and a sense of agency through whatever means and channels are available. Passivity and debility became a way of life for affluent Victorian women. Self help, “healthy living,” drug/herb/supplement regimens, and therapy can become a way of life for the affluent today. It’s the active side of the same coin.

As an aside, I am waiting for the “gluten free” fad to succumb to science and be recognized in 99% of cases as stress, nocebo, and other dietary problems.

Speaking as a celiac – you chose the wrong example there. Yes its a fad diet, which I too hate, almost as much as I hate the prevalent notion that celiac isn’t real. It’s a scientifically recognized condition, complete with tests and happily enough its a condition that doesn’t require medication, simply a change in diet.

I did say 99%, not 100%. I understand that celiac is absolutely real, but too often erroneously self diagnosed. There are all sorts of medical conditions that undoubtedly exist but are over-diagnosed. To get back to the theme of Venkat’s post, self/over diagnosed to fill a void.

I suppose so, just don’t forget the part and promise that “real” science itself plays. Any discussion of science by the laity, even the smart laity (esp, in the “Humanities”), is simply at the level of mimicry.

It’s the allure of statistical analysis, good evidence perhaps, but not enough in-and-of-itself to grant unbridled authority to the point being made with those statistics; the linkage between that “point” and the data is often political or otherwise contaminated by levels of uncertainty.

I thought this piece was interesting, but think-pieces must be grounded in facts. This wasn’t. First, you need to present data on coffee and alcohol consumption over the past century, even if that data isn’t perfect. I think your caricature of coffee’s growth in importance is in its broad strokes correct; your one of alcohol is not. I do think it’s possible that you meant something correct, but that isn’t what you said. This piece seems to imply that you think alcohol consumption and use is on the rise? Maybe over the past ten years, but Americans drink MUCH LESS than we did before Prohibition so, you know, it did sort of work. I don’t know about amounts consumed, but patterns of consumption have also changed to be less abuse-friendly than they were in the fifties and sixties, when drinking at one’s office during work hours was usually acceptable. And where this piece could have used data to actually get an accurate historical perspective, I wish the author had spent any time thinking about the biases and blind spots in his/her geographical perspective. I would have appreciated an attempt by the author to get out of his/her Pacific Northwest localism. Sure, it’s a bit of a center, but sure as hell not more so than the Silicon Valley, and I don’t think more so than ever-expanding Texas with its own technology hubs. Cool idea, especially the stuff about invalidism, but I was deeply unimpressed by most of the author’s analysis of our current transformation.

You may already be aware, but I found it a curious coincidence that one of your current preoccupations – cargo cults – is also this year’s Burning Man theme. The hipsters may be more self-aware than we give them credit for.

Noone seems to have commented on this yet — anitdepressants are also used to treat very real, non imagined states of being. I myself don’t have first hand experience with them but if you read the accounts of people dealing with deep depression, it is sadness on a whole other level.

Another point, what if the internal has just as much if not more impact on a person’s being than the external? There’s not much discussion of that here. What if for some people, depression is caused by things like poor diet and food allergies which are putting the body into a state of stress, which eventually deregulates the brain. Or people with thyroid disorders.